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With over 15 years of experience in management consulting, Olaf is a proven leader in the strategic application of technology to resolve operational business challenges. As the primary lead of Optimity’s Claims Accuracy service offering, Olaf employs quantitative and qualitative analysis to identify underlying root causes of issues and define targeted solutions that result in the highest impact to organizations.

Industry

Olaf Reyes

Experience

Olaf has extensive experience in leading large systems integrations teams in the implementation of enrollment and claims transaction audit and control solutions, and in developing end-to-end solutions for web enrollment, billing, and sales automation. He has functional expertise in Enrollment and Eligibility, Claims Pricing and Adjudication, Business Process Reengineering, and Process Improvement.

Developed and implemented Claims Accuracy programs for multiple health plans

Led and implemented the claims accuracy program for a managed Medicaid plan identifying over $20M in claims inaccuracies and $16M in recoverable findings across the plan’s institutional and professional providers

Developed and implemented a Payment Accuracy Center of Excellence for a national Managed Medicaid insurer that identified over $6M in claim inaccuracies and rolled out people, process, and technology initiatives to address underlying root cause

Developed a contract modeling and simulation analytics application for a managed Medicaid plan to assess the financial impact of state mandated payment methodology and provider network changes to assist the plan in developing new provider contracts

Re-engineered and re-platform electronic enrollment system

Lead business team in defining functional, business rules, operational reports, and dashboards requirements to re-engineer a regional Blue Cross Blue Shield plan’s electronic enrollment system doubling transaction capacity and providing near-real time processing capabilities